This project will demonstrate and evaluate two models of supported employment services for 150 individuals with severe and persistent mental illness in the Concord and Manchester catchment areas of New Hampshire. Vocational services for this population, including supported employment, have not been well defined as interventions or well researched as to outcomes and costs. The project will fully operationalize and monitor the two models. The study will examine the models' cost-effectiveness, clients' employment outcomes and clients' outcomes on several measures of psychiatric symptoms and psychosocial functioning. In the Individual Placement and Support (IPS) model, a vocational specialist is a member of the client's treatment team at the community mental health center. With individual counseling from the specialist, the client prepares to seek a job, obtains a job and training, and maintains employment. The community mental health centers in Concord and Manchester will provide IPS services, with training from Boston University (BU) and ongoing clinical supervision from a vocational consultant familiar with the IPS model. In the Group Skills Training (GST) model, vocational and placement personnel work with groups of clients at an independent employment agency. The client receives specific training and support in choosing, getting, and keeping a job. The employment agency providing GST services in both Concord and Manchester is Employment Connections Specialists, Inc.; staff will receive training and ongoing supervision from BU. In both models, the community mental health center makes the referrals and provides mental health services, including followup on the job. The project includes systems for skill training of all staff at the outset and for continuous monitoring and supervision to assure model adherence. The study design and methods include randomization to treatments; baseline assessment of demographics, diagnosis, employment history, and vocational readiness; and current adjustment (psychiatric symptoms, medication compliance, social support and network, residential stability, self-esteem, and quality of life). Follow-up at 6, 12, and 18 months will examine employment outcomes (employment status, hours worked, wages earened); current adjustment, institutionalization, and quality of life; and service utilization. Of particular interest, the investigators will examine medication compliance and social support and networks at baseline and follow-up. Analysis of cost-effectiveness will encompass employment outcomes, resources consumed (services used), and unit costs for each category of resources. The investigators hypothesize that the GST model will be more cost-effective than IPS in effecting positive employment outcomes, that clients who comply with medication and who have social support will do better in both GST and IPS, and that clients who have positive employment outcomes will also have more positive outcomes on the measures of current adjustment.